04 Sep Vaginismus & Vulvodynia: a GP’s perspective
Have you heard of vaginismus? Ever been affected by vulvodynia?
Both are two common conditions that impact the lives of many Australian women – sexually and psychologically.
As a GP, I’m often the first person that women turn to when they have painful penetrative sex or painful vulva. In many cases, it’s either vaginismus or vulvodynia.
Currently, we’re not 100% aware of what causes these conditions. What we do know is that they can be treated effectively with time and patience, typically accompanied by a good dose of physiotherapy.
Let’s explore these two conditions below.
Vaginismus is an involuntary spasm of the vaginal muscles due to a deep emotional inability to relax these muscles to allow penetration. In almost all cases, the vulva and vagina are completely healthy.1
The effects of the condition can range from occasional painful sex, through to not being able to use a tampon. Gynaecological examinations and cervical screening tests can be a nightmare for some women.
As touched on above, no-one really knows what causes vaginismus.
Many experts believe that it’s more often than not psychologically-driven, where sex is deemed taboo or anticipated to be painful. Patients I see for vaginismus sometimes come from conservative backgrounds. Others have experienced some form of sexual, physical or psychological abuse in the past. However, I’ve seen women from all walks of life.
Further causes may include childbirth, urinary tract infections, thrush or even chronic pain syndromes2 such as myofascial pelvic pain syndrome.
Lots of options exist for treatment of this embarrassing, stressful and painful condition.
I regularly refer to specialist pelvic floor physiotherapists for vaginismus. They’re experts at educating women about the muscles of their pelvic floor and how to strengthen and relax these muscles. For the most part, some therapy to relax the muscles is what’s required.
Your physio or GP may recommend vaginal dilators. These generally come in the form of unintimidating plastic tubes of gradual sizes that are inserted into the vagina.
Specialist sexual counselling is also commonly advised. This has proved to be very effective when combined with other physical treatments.
While the treatment options can seem quite daunting, women should feel reassured that all treatments are done with utmost care and consideration.
What about sex?
While being treated, women can enjoy the many forms of non-penetrative sex.
Apart from your brain, the clitoris is your biggest sex organ. During treatment, it can be helpful to take penetration off the menu and concentrate on clitoral stimulation.
A break from penetrative sex can help re-introduce the concepts of arousal and desire that may have faded. Patients often find this approach leads to improved attitudes towards sex and a gradual reduction in vaginismus symptoms.
Vulvodynia is a condition where there’s chronic pain, burning or discomfort in the vulva that can’t be linked to a specific cause3. In severe cases, the condition can have a significant impact on your sex life, exercise and work.
Vulval pain can result from the lightest touch and can be localised or felt across the entire vulva area. Women diagnosed with vulvodynia typically don’t exhibit any visual vulval abnormalities.
There are a few subtypes of vulvodynia, the most common being Vulvar Vestibulitis Syndrome (VVS). VVS is claimed to affect up to 15% of women4 and is specific to pain only in the vestibule. The vulvar vestibule is the area inside your labia minora just before the vaginal entry.
I’ve treated patients of all ages for vulvodynia and VVS, though it seems to be more common in younger women. The condition can last anywhere from a couple of weeks to many years.
Unfortunately, the causes of vulvodynia are also largely unknown.
Some researchers believe that contributing factors include:
- damaged nerve endings around the vestibule, typically due to childbirth or sexual trauma
- past infections
- allergies and sensitive skin
- increased pelvic floor muscle tension
- hormonal changes
As with vaginismus, there are many treatment options.
Physiotherapy addresses the physical pain of overactive muscles and nerves in the area. This helps to reduce pain and achieve comfortable sexual intimacy.
Your GP may prescribe medications and recommend topical creams to help with relief. These can include tricyclic antidepressants, nerve blockers, estrogen creams and local anaesthetics, such as lidocaine.
You may need to safely try a combination of treatment techniques to discover what works best for you. Speak with a medical professional before heading down this path.
Women that suffer extremely painful vulvodynia may consider cognitive behaviour therapy (CBT), hypnotherapy or acupuncture. In the most severe of cases, surgery may be required to remove the area causing acute pain.
Sex is often avoided by women who suffer from vulvodynia pain, and understandably so. However, there are numerous options for enjoying sexual intimacy while symptoms are present.
Penetrative sex can be made more comfortable with the use of safe, non-irritating lubricants. Be sure to have plenty on hand – especially when using condoms.
Trialling different positions that avoid excess contact with the affected area of your vulva may also help. Some patients report that penetration from behind is an effective position.
It must be noted that vulvodynia and VVS can impact vaginismus. You may need to address both conditions before you can completely enjoy painless intercourse again.
Dr Sung refers to expert physiotherapists for this condition such as Annette Beauchamp of SHE.
Dr Elaine Sung is a local GP and owner of Doctors of South Melbourne. Her areas of special interest include women’s health and sexual health.
4 Gardella, C. (2006). Vulvar vestibulitis syndrome. Curr Infec Dis Rep, 8(6), 473-480.